Skip to main content
SpringerLink
Log in

Prediction of Postpartum Hemorrhage by Sonographic Uteroplacental Morphology in Placenta Previa

  • Surgery
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

The aim of this study was to determine the effect on the amount of hemorrhage in placenta previa of the size and number of lacunae and the thickness of the myometrial tissue below the placenta at the thinnest part. A total of 58 patients with placenta previa were separated into two groups according to the presence or not of placental lacunae. The number of lacunae, the size of the lacuna with the maximum diameter, and the thickness of the myometrial tissue below the placenta at the thinnest part were measured. The patients were delivered by cesarean section between the 36th and 38th weeks. The operating time, decrease in hemoglobin level, and the need for additional surgical procedures were recorded. The myometrial thickness below the thinnest placental part was lower in the group without lacunae, but not statistically significant. The need for additional surgical intervention during the operation was higher in patients with placental lacunae. The number of lacunae, the size of the largest lacuna, and the thinnest myometrial thickness could statistically significantly predict hemoglobin change (p = 0.025, p<0.001, and p<0.001, respectively), and these variables accounted for 68.1% of the explained variability in hemoglobin change. The maximum lacuna size and the thinnest myometrial thickness could statistically significantly predict average surgery duration (p<0.001 and p<0.001, respectively), and these variables accounted for 72.3% of the explained variability in average surgery duration. In conclusion, the size and number of the lacunae or the thickness of the myometrial tissue below the placenta at the thinnest part can be used to predict the decrease in hemoglobin levels and the operating time in patients with placenta previa totalis, which will enable optimal necessary preoperative measures to be taken.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hasegawa J, Matsuoka R, Ichizuka K, Mimura T, Sekizawa A, Farina A, et al. Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa. Ultrasound Obstet Gynecol. 2009;34(1):80–4.

    Article  CAS  Google Scholar 

  2. Widmer M, Blum J, Hofmeyr GJ, Carroli G, Abdel-Aleem H, Lumbiganon P, et al. Misoprostol as an adjunct to standard uterotonics for treatment of post-partum haemorrhage: a multicentre, double-blind randomised trial. Lancet. 2010;375(9728):1808–13.

    Article  CAS  Google Scholar 

  3. American College of O, Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039–47.

    Article  Google Scholar 

  4. Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet. 2011;284(1):47–51.

    Article  Google Scholar 

  5. Lerner JP, Deane S, Timor-Tritsch IE. Characterization of placenta accreta using transvaginal sonography and color Doppler imaging. Ultrasound Obstet Gynecol. 1995;5(3):198–201.

    Article  CAS  Google Scholar 

  6. Timor-Tritsch IE, Bar-Yam Y, Elgali S, Rottem S. The technique of transvaginal sonography with the use of a 6.5 MHz probe. Am J Obstet Gynecol. 1988;158(5):1019–24.

    Article  CAS  Google Scholar 

  7. Oya A, Nakai A, Miyake H, Kawabata I, Takeshita T. Risk factors for peripartum blood transfusion in women with placenta previa: a retrospective analysis. J Nippon Med Sch. 2008;75(3):146–51.

    Article  Google Scholar 

  8. Giambattista E, Ossola MW, Duiella SF, Crovetto F, Acaia B, Somigliana E, et al. Predicting factors for emergency peripartum hysterectomy in women with placenta previa. Arch Gynecol Obstet. 2012;285(4):901–6.

    Article  Google Scholar 

  9. Sekiguchi A, Nakai A, Kawabata I, Hayashi M, Takeshita T. Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage. Int J Med Sci. 2013;10(12):1683–8.

    Article  Google Scholar 

  10. Lee HJ, Lee YJ, Ahn EH, Kim HC, Jung SH, Chang SW, et al. Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall. Obstet Gynecol Sci. 2017;60(6):520–6.

    Article  Google Scholar 

  11. Reynolds SR, Hellman LM, Bruns P. Patterns of uterine contractility in women during pregnancy. Obstet Gynecol Surv. 1948;3(5):629–46.

    Article  CAS  Google Scholar 

  12. Hackethal A, Brueggmann D, Oehmke F, Tinneberg HR, Zygmunt MT, Muenstedt K. Uterine compression U-sutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique. Hum Reprod. 2008;23(1):74–9.

    Article  CAS  Google Scholar 

  13. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99(3):502–6.

    CAS  PubMed  Google Scholar 

  14. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997;104(3):372–5.

    Article  CAS  Google Scholar 

  15. Said Ali A, Faraag E, Mohammed M, Elmarghany Z, Helaly M, Gadallah A, et al. The safety and effectiveness of Bakri balloon in the management of postpartum hemorrhage: a systematic review. J Matern Fetal Neonatal Med. 2019:1–8.

  16. Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol. 2017;216(3):300 e1–5.

    Article  Google Scholar 

  17. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96(1):129–31.

    CAS  PubMed  Google Scholar 

  18. Lee JY, Ahn EH, Kang S, Moon MJ, Jung SH, Chang SW, et al. Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa: a retrospective cohort study. J Obstet Gynaecol Res. 2018;44(1):54–60.

    Article  Google Scholar 

  19. Mimura T, Hasegawa J, Nakamura M, Matsuoka R, Ichizuka K, Sekizawa A, et al. Correlation between the cervical length and the amount of bleeding during cesarean section in placenta previa. J Obstet Gynaecol Res. 2011;37(7):830–5.

    Article  Google Scholar 

  20. Mehrabadi A, Hutcheon JA, Liu S, Bartholomew S, Kramer MS, Liston RM, et al. Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage. Obstet Gynecol. 2015;125(4):814–21.

    Article  Google Scholar 

  21. Shetty MK, Dryden DK. Morbidly adherent placenta: ultrasound assessment and supplemental role of magnetic resonance imaging. Semin Ultrasound CT MR. 2015;36(4):324–31.

    Article  Google Scholar 

  22. Berkley EM, Abuhamad A. Imaging of placenta accreta spectrum. Clin Obstet Gynecol. 2018;61(4):755–65.

    Article  Google Scholar 

  23. Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders.  Best Pract Res Clin Obstet Gynaecol. 2020;S1521-6934(20):30116-4. https://doi.org/10.1016/j.bpobgyn.2020.06.010.

  24. Yoon SY, You JY, Choi SJ, Oh SY, Kim JH, Roh CR. A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Eur J Obstet Gynecol Reprod Biol. 2014;180:111–5.

    Article  Google Scholar 

  25. Baba Y, Ohkuchi A, Usui R, Suzuki H, Kuwata T, Matsubara S. Calculating probability of requiring allogeneic blood transfusion using three preoperative risk factors on cesarean section for placenta previa. Arch Gynecol Obstet. 2015;291(2):281–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Perinatology, Ministry of Health, Ankara City Hospital, Cankaya, Ankara, Turkey

    Orhan Altinboga, Seyit Ahmet Erol, Betul Yakistiran & Aykan Yucel

  2. Department of Perinatology, University of Health Sciences, Etlik Zubeyde Hanim Women’s Health Care, Training and Research Hospital, Ankara, Turkey

    Kemal Sarsmaz

  3. Department of Biostatistics, Ankara University, Ankara, Turkey

    Batuhan Bakirarar

Authors
  1. Orhan Altinboga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kemal Sarsmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyit Ahmet Erol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Betul Yakistiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Batuhan Bakirarar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aykan Yucel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Orhan Altinboga: Protocol development, data collection, and manuscript writing

Kemal Sarsmaz: Data collection and data analyses

Seyit Ahmet Erol: Data collection

Betul Yakistiran: Data collection

Batuhan Bakirarar: Statistical analysis

Aykan Yucel: Protocol development and manuscript editing

Corresponding author

Correspondence to Orhan Altinboga.

Ethics declarations

Ethics Approval

Ethics committee approval was granted by the Local Ethics Committee (Decision Number: E1/1004).

Consent to Participate

Informed consent was obtained from all the study participants.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Altinboga, O., Sarsmaz, K., Erol, S.A. et al. Prediction of Postpartum Hemorrhage by Sonographic Uteroplacental Morphology in Placenta Previa. SN Compr. Clin. Med. 3, 659–665 (2021). https://doi.org/10.1007/s42399-021-00802-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-021-00802-w

Keywords

Search

Navigation